Design and Implementation of a Digitally Enabled Care Pathway to Improve Management of Depression in a Large Health Care System: Protocol for the Implementation of a Patient Care Platform

Abstract

Background Major depressive disorder (MDD) is a serious public health concern worldwide. A treatment approach that incorporates measurement-based care (MBC) and shared decision-making between patients with MDD and their providers may foster patient engagement and improve clinical outcomes. While digital tools such as mobile apps show promise for expanding health interventions, these apps are rarely integrated into clinical practice. Objective The primary objective of this ongoing study is to determine whether implementation of a digital tool—the Pathway Platform—in primary care improves adherence to MBC practices; here, we present the study methods. Methods This large-scale, real-world implementation study is based on a pilot study of an earlier iteration of a mobile app (the Pathway app) that confirmed the feasibility of using the app in patients with MDD and showed a positive trend in patient engagement in the app arm. In addition, a user-centered design approach that included qualitative assessments from patients and providers was used to improve understanding of the patient journey and care team workflows. User feedback highlighted the need for enhanced features, education modules, and real-time data sharing via integration with the electronic health record. The current iteration of the Platform includes the newest version of the Pathway app, education modules for both patients and providers, and real-time patient-level data sharing with the electronic health record. The study takes place in primary care sites within the Advocate Aurora Health system in Illinois and includes adult patients with MDD who were recently prescribed monotherapy antidepressant medication (defined as a new start, medication switch, or dose change in the past 3 months). Clinical performance and selected patient outcomes will be compared before and after the implementation of the Platform. Results Patient recruitment was completed in July 2022, with initial results expected in mid-2023. Conclusions This study will provide useful insights into real-world integration of a digital platform within a large health system. The methods presented here highlight the unique user-centric development of the Pathway Platform, which has resulted in an enhanced digital tool with the potential to foster MBC and shared decision-making, improve patient-provider communication, and ultimately lead to optimized treatment outcomes for patients with MDD. Trial Registration ClinicalTrials.gov NCT04891224; https://clinicaltrials.gov/ct2/show/NCT04891224 International Registered Report Identifier (IRRID) DERR1-10.2196/43788

User-Centered Design of a Digitally Enabled Care Pathway in a Large Health System: Qualitative Interview Study

“…The study will include up to 200 patients at 20 primary care clinics. The implementation study aims to test the scaling and integration of Pathway Platform , along with educational interventions, at multiple primary care sites within the AAH system, with the primary objective of determining improvement in adherence to MBC practices [ 32 ]. Results are expected to provide insights into the improvements in clinical workflows that are necessary to enhance collaborative care, depression management, clinician and patient experience, adherence to medication, patient-provider engagement, and depression outcomes in the primary care setting [ 32 ].…”

“…The implementation study aims to test the scaling and integration of Pathway Platform , along with educational interventions, at multiple primary care sites within the AAH system, with the primary objective of determining improvement in adherence to MBC practices [ 32 ]. Results are expected to provide insights into the improvements in clinical workflows that are necessary to enhance collaborative care, depression management, clinician and patient experience, adherence to medication, patient-provider engagement, and depression outcomes in the primary care setting [ 32 ]. EHR integration and how it enables decision-making, and efficiencies with current AAH information technology platforms, such as ease of access of data in real time by the care team, will also be assessed.…”

“…EHR integration and how it enables decision-making, and efficiencies with current AAH information technology platforms, such as ease of access of data in real time by the care team, will also be assessed. Together, insights from this study will allow further amendment of workflows to ensure the optimal use of Pathway Platform [ 32 ].…”

“…Building on these results, a new iteration of the app was created and incorporated into a new digital platform, Pathway Platform , which includes the Pathway App ; EHR-integrated, real-time, patient-level data sharing; and educational programming that is both care team and patient facing. This was guided by a more comprehensive understanding of care team workflows and patient and care team insights [ 32 ]. In this paper, we describe how user-centered design was applied to develop a digitally enabled MDD care platform that is optimized for the needs of patients living with MDD and their primary care teams.…”

Comparison of the Efficacy Between Standard Measurement-Base Care (MBC) and Enhanced MBC for Major Depressive Disorder: A Pilot Study

“…To date, only a limited number of studies have explored the use of technology enhanced MBC for the treatment of depression, 26 , 27 with scant evidence regarding the efficacy of enhanced MBC. To address this gap, we initiated an international cooperation study, the Enhanced Measurement-Based Care Effectiveness for Depression (EMBED).…”